Your Cart ()
cload

GUARANTEED SAFE & SECURE CHECKOUT

Article review: ED crowding and education

By Michelle Lin, MD March 15, 2010 0 comments

HeartStopsm

“The effect of ED crowding on education”

My heart almost stopped when I read this article title in Amer J of Emerg Med. This was the premise of my recently completed study – using a prospective, time-motion methodology. I’m in the process of writing the manuscript. Did I get scooped by my friends at U Penn?

Whew. Fortunately, no. Different methodology.

This study was a cross-sectional study looking at learner assessment of education, using a validated tool called the ER (Emergency Rotation) Score. The results are interesting.

The problem

We know that ED crowding negatively impacts clinical care. How does it impact our teaching of medical students and residents? The ED is traditionally known as a great place for learning how to resuscitate high-acuity patients, to manage and risk-stratify undifferentiated cases, and to perform procedures. Experientially, I feel like I teach less when it gets extremely crowded.

Methodology

Over a 5-week period, 43 residents and 3 medical students prospectively assessed 34 attendings using a simple ER Score tool. There were 352 separate encounters. This validated tool assessed the attending based on 4 domains (teaching, clinical care, approachability, helpfulness) with each domain assessed on a 5-point scale. The scores were correlated with crowding measures (waiting room number, occupancy rate, number of admitted patients, and patient-hours).

ERScoresm
ER Score tool

What was their enrollment scheme?

Upon arrival, the research assistant selected the patient with the most recent admission order where the learner-attending pair was still present in the ED. The learner was asked to fill out the ER Score tool. For each admitted patient case, the research assistant also enrolled a non-admitted patient with a similar triage intake time. The learner for this non-admitted case was also asked to fill out the ER Score tool. The study group intentionally structured this methodology to oversample admitted patients, which they assumed impacted education more than non-admitted patients.

Results

The median score was 16 of 20. ED crowding levels were NOT associated with ER scores or their individual domains.

How fascinating that learners still felt that the quality of teaching and learning in the ED was maintained despite the ED being overwhelmed beyond capacity.

The next step is to follow Kirkpatrick’s model in conducting educational research. In this model, satisfaction/reaction-based studies are the first (lowest) tier. Such studies inherently have flaws based on bias, recall, and halo effect. The next study is to look at more objective measures assessing the impact of crowding on education. Hmm, I better get going on my manuscript.

Kirkpatrick.jpgKirkpatrick’s 4-tiered model to evaluate training and education

Reference
Pines JM, Prabhu A, McCusker CM, Hollander JE. The effect of ED crowding on education. Amer J Emerg Med (2010) 28, 217–220.

 

Author information

Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

The post Article review: ED crowding and education appeared first on ALiEM.


Older Post Newer Post

Newsletter

Categories

B. Dupont Purchased 1 minute ago from Los Angeles, CA
2
C. Santos Purchased 2 minutes ago from Chicago, IL
5.11 FLEX TacMed Pouch
D. Kim Purchased 1 minute ago from Houston, TX
5.11 FLEX Tourniquet Pouch
E. García Purchased 1 minute ago from Phoenix, AZ
5.11 UCR TacReady Headrest Pouch
F. Müller Purchased 1 minute ago from Philadelphia, PA
Abdominal Aortic and Junctional Tourniquet-Stabilized (AAJT-S)
G. Rossi Purchased 1 minute ago from San Antonio, TX
Adjustable Flange Nasopharyngeal Airway
H. Martinez Purchased 1 minute ago from San Diego, CA
Adult Bag Valve Mask
J. López Purchased 1 minute ago from Dallas, TX
Altama OTB Maritime Assault Boot - Low Height
K. Nowak Purchased 2 minutes ago from San Jose, CA
Altama OTB Maritime Assault Boot - Mid Height
L. Müller Purchased 1 minute ago from Austin, TX
AMBU Perfit ACE Adjustable Cervical Extrication Collar
M. Ivanova Purchased 2 minutes ago from Jacksonville, FL
Amphibious Trauma Kit
N. Andersen Purchased 2 minutes ago from Fort Worth, TX
Army CLS Resupply Kit (CLS™)
O. Fischer Purchased 1 minute ago from Columbus, OH
Backpack Accessory Pouch Kit - 4 Color
P. Bernard Purchased 1 minute ago from Charlotte, NC
Ballistic Soft Panel for Plate Carrier
S. Schmidt Purchased 1 minute ago from San Francisco, CA
Bandage Fill Kit
T. Kowalski Purchased 2 minutes ago from Indianapolis, IN
Bandage Shears
X. Martinez Purchased 2 minutes ago from Seattle, WA
Bard-Parker Safety Scalpel #10
Y. Ahmed Purchased 1 minute ago from Denver, CO
Basic Field Surgical Airway Kit w/ET Tube
Z. Khan Purchased 1 minute ago from Washington, DC
Beacon Chest Seal - Occlusive/Non-Vented
A. Ali Purchased 2 minutes ago from Boston, MA